NPIMap

Organization Active NPI

Prairie Community Services

Doing business as Fresh Start PCS

  • Mental Illness Community Based Residential Treatment Facility
  • Duluth, MN
National Provider Identifier
1578808663
Registry record updated Jul 24, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
License
FBL-21674-37286 Issued in MN
Legal business name
PRAIRIE COMMUNITY SERVICES
Doing business as
Fresh Start PCS
Practice address
1610 E 1St St
Duluth, MN 55812-1650
Phone
(218) 724-2945
NPI assigned
Nov 30, 2012
Last updated
Jul 24, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
ST. FRANCIS HEALTH SERVICES OF MORRIS, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 24, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Sherry L Wagner
Title
Cfo
Phone
(320) 589-4919

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X 1060122-1-RMI MN
Mental Illness Community Based Residential Treatment Facility 320800000X FBL-21674-37286 MN Primary

Addresses

Primary practice location

1610 E 1St St
Duluth, MN 55812-1650

Mailing address

801 Nevada Ave Ste 100
Morris, MN 56267-1874
Phone (320) 589-2004

Other names 1

  • Fresh Start PCS Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Prairie Community Services18 organizations share this tax ID, including this one
Part of
St Francis Health Services of Morris Inc

Other organizations with this tax ID 17

Organizations that report the same tax identification number in the National Provider Directory.

View all 17

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1354233600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1374624000000",
    "number": "1578808663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 NEVADA AVE STE 100",
            "city": "MORRIS",
            "state": "MN",
            "postal_code": "562671874",
            "telephone_number": "320-589-2004",
            "fax_number": "320-589-1270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1610 E 1ST ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558121650",
            "telephone_number": "218-724-2945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAIRIE COMMUNITY SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST. FRANCIS HEALTH SERVICES OF MORRIS, INC",
        "enumeration_date": "2012-11-30",
        "last_updated": "2013-07-24",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "SHERRY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "320-589-4919",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "MN",
            "license": "1060122-1-RMI",
            "primary": false
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "MN",
            "license": "FBL-21674-37286",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fresh Start PCS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Duluth, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.